The issue of renal and visceral protection during thoracoabdominal aorta repair is still relevant. The incidence of postoperative acute kidney injury ranges from 21% to 63%. This event is accompanied by high postoperative mortality (up to 32%). Moreover, this value is increased up to 63% if postoperative renal replacement therapy is required. Postoperative complications associated with visceral organ lesion are less common, but also accompanied by significant mortality (up to 40%). The main cause of organ damage is ischemia during aortic repair with visceral and renal artery reconstruction. Some protective strategies are used to minimize ischemia time: distal aortic perfusion, systemic hypothermia and selective visceral and renal artery perfusion. The purpose of selective perfusion is ensuring adequate and sufficient blood flow and elimination of organ ischemia. Nevertheless, literature data indicate the imperfection of this technology that results persistent organ damage. Thus, more efficient systems and optimizing the volumetric perfusion rate are required.